Crossed buccofacial apraxia
R. B. Mani and D. N. Levine
Neurology Service, Spaulding Rehabilitation Hospital, Boston.
The cerebral hemisphere contralateral to the preferred hand is generally
dominant for learned representational motor acts, including those involving
buccofacial muscles. It is generally also language-dominant. This
buccofacial apraxia has, with rare exceptions, been associated with left
hemispheric lesions in right-handers. We describe two patients with severe
buccofacial apraxia caused by large middle cerebral artery territory
infarcts in the hemisphere ipsilateral to the preferred hand and
nondominant for language. Neither patient had aphasia or major limb
apraxia. Computed tomographic scans in the first patient and
neuropathologic examination in the second failed to reveal an abnormality
of the hemisphere contralateral to the preferred hand. Hence, in some
individuals, the hemisphere controlling skilled representational
buccofacial movements may not be the one that is dominant either for
handedness or for language.
